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пациента в отношении собственного здоровья, предпочтениях и его ценностях [565, 566, 567].

ЕОК I В (УУР С, УДД 4).

В случае рассмотрения имплантации нового ИКД*** или замены имеющегося ИКД*** в

связи с разрядом батареи у пациента, рекомендуется информировать его/ее об индивидуальном риске ВСС и риске невнезапной смерти от ХСН или несердечных заболеваний, а также об эффективности, безопасности и потенциальных осложнениях ИКД*** в свете цели самого пациента в отношении его здоровья, предпочтений и ценностей [565, 567, 568].

ЕОК I В (УУР В, УДД 3).

Критерии оценки качества медицинской помощи

 

 

 

 

 

 

EОК

 

 

Оценка

 

 

Критерий качества

 

Класс и

УУР

УДД

выполн

 

 

 

 

 

 

уровень

 

 

ения

1.

Пациенту

с

остановкой кровообращения /

 

 

 

Да/нет

 

синкопальным эпизодом выполнено ЭКГ и при

А

2

 

 

диагностировании пароксизма ЖТ/ФЖ выполнены

 

 

 

 

 

реанимационные

мероприятия и

экстренная

 

 

 

 

 

кардиоверсия/дефибрилляция.

 

 

 

 

 

2.

Пациенту с устойчивой желудочковой тахикардией

А

2

Да/нет

 

выполнено купирование аритмии (медикаментозное,

 

 

 

 

 

ЭИТ).

 

 

 

 

 

 

 

 

3.

Выполнено

ЭКГ-исследование покоя в 12-ти

 

 

 

 

 

отведениях и/или холтеровское мониторирование

IA

А

2

Да/нет

 

ЭКГ (ХМ-ЭКГ) пациентам при прохождении

 

 

 

 

 

обследования на предмет выявления желудочковых

 

 

 

 

 

аритмий (ЖА).

 

 

 

 

 

 

 

4.

Выполнено

эхокардиографическое

исследование

 

 

 

 

 

и/или другие визуализирующие исследования для

IA

А

1

Да/нет

 

оценки функции ЛЖ и выявления структурной

 

 

 

 

 

патологии сердца у пациента с ЖА.

 

 

 

 

 

5.

Начата/продолжена

терапия

бета-

 

 

 

 

 

адреноблокаторами в лечении всех категорий

 

 

 

 

 

пациентов

 

со

структурным

поражением

IA

А

1

Да/нет

 

миокарда/дисфункцией ЛЖ, имеющих повышенный

 

 

 

 

 

риск ВСС и нуждающихся в её первичной или

 

 

 

 

 

вторичной профилактике.

 

 

 

 

 

6.

Проведена

оптимальная медикаментозная терапия

 

 

 

 

 

ингибиторами АПФ (или ангиотензина II

 

 

 

 

 

антагонистами

при

непереносимости

ингибиторов

I A

В

2

Да/нет

 

АПФ), бета-адреноблокаторами и антагонистами

 

 

 

 

 

альдостерона пациентам с ХСН и систолической

 

 

 

 

 

дисфункцией ЛЖ (ФВЛЖ ≤ 35–40%) с целью

 

 

 

 

 

снижения общей смертности и риска ВСС.

 

 

 

 

 

 

 

 

 

 

 

 

 

86

7.

При повторных срабатываниях/шоках ИКД***

 

 

 

 

 

вследствие

устойчивой

ЖТ

проведена

А

2

Да/нет

 

антиаритмическая терапия, при неэффективности

 

 

 

 

 

или невозможности которой пациент направлен на

 

 

 

 

 

консультацию к врачу, специализирующемуся на

 

 

 

 

 

диагностике и

лечении нарушений

ритма

сердца

 

 

 

 

 

(кардиологу, сердечно-сосудистому хирургу, врачу

 

 

 

 

 

рентгенэндоваскулярной диагностики и лечения)

 

 

 

 

 

для решения вопроса о необходимости выполнения

 

 

 

 

 

катетерной аблации.

 

 

 

 

 

 

 

 

8.

Пациент

с сохраняющейся

дисфункцией

левого

 

 

 

 

 

желудочка (ФВЛЖ – 35% и менее) и сердечной

А

1

Да/нет

 

 

 

 

 

 

недостаточностью (II или III ФК по NYHA), через 40

 

 

 

 

 

дней после инфаркта миокарда, направлен на

 

 

 

 

 

консультацию к врачу, специализирующемуся на

 

 

 

 

 

диагностике и

лечении нарушений

ритма

сердца

 

 

 

 

 

(кардиологу, сердечно-сосудистому хирургу, врачу

 

 

 

 

 

рентгенэндоваскулярной диагностики и лечения)

 

 

 

 

 

или в специализированный кардиологический центр

 

 

 

 

 

для решения вопроса о необходимости имплантации

 

 

 

 

 

ИКД***.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

При непрерывной некупирующейся ЖТ или

 

 

 

 

 

электрическом

 

шторме,

приводящим

к

А

2

Да/нет

 

многократному

 

повторному

нанесению

шоков

 

 

 

 

 

ИКД***, с врачом, специализирующимся на

 

 

 

 

 

диагностике и

лечении нарушений

ритма

сердца

 

 

 

 

 

(кардиологом, сердечно-сосудистом хирургом,

 

 

 

 

 

врачом

рентгенэндоваскулярной диагностики

и

 

 

 

 

 

лечения)

обсуждена необходимость катетерной

 

 

 

 

 

аблации в специализированных и опытных центрах.

 

 

 

 

10.

При безуспешности медикаментозной терапии,

 

 

 

 

 

сохранении приступов ЖТ, наличии дисфункции

А

2

Да/нет

 

ЛЖ,

ассоциированной

с

желудочковой

 

 

 

 

 

экстрасистолией,

пациент

направлен

 

на

 

 

 

 

 

консультацию к врачу, специализирующемуся на

 

 

 

 

 

диагностике и

лечении нарушений

ритма

сердца

 

 

 

 

 

(кардиологу, сердечно-сосудистому хирургу, врачу

 

 

 

 

 

рентгенэндоваскулярной диагностики и лечения)

 

 

 

 

 

или в специализированный кардиологический центр

 

 

 

 

 

для решения вопроса о необходимости катетерной

 

 

 

 

 

аблации для профилактики рецидивов аритмии и

 

 

 

 

 

повторных срабатываний ИКД.

 

 

 

 

 

 

 

87

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